effects of preemptive tramadol and dexmedetomidine on shivering during arthroscopy

Shivering, the rate of which in regional anesthesia is 39% is an undesired complication seen postoperatively. This study aims to compare the ability of preventing the shivering of preemptive tramadol and dexmedetomidine during the spinal anesthesia [SA]. A total of 90 patients with American Society of Anesthesiologists physical status I-II, aged 18-60 years and undergoing elective arthroscopic surgery with SA were divided into three groups randomly. After spinal block, 100 mg tramadol in 100 ml saline was applied in group T- [n = 30] and 0.5 microg/kg dexmedetomidine in 100 ml saline was applied in group D- [n = 30] and 100 ml saline was administered in group P- [n = 30] in 10 min. The hemodynamics, oxygen saturation, tympanic temperature, shivering and sedation scores were evaluated and recorded intraoperatively and 45 min after a postoperative period. In group T and D, shivering scores were significantly lower when compared with group P in the intraoperative 20th min [P = 0.01]. Sedation scores in group D were significantly higher than the baseline values [P = 0.03] and values in group T and P [P = 0.04]. Preemptive tramadol and dexmedetomidine are effective in preventing the shivering under SA. In addition, dexmedetomidine was superior in increasing the level of sedation which is sufficient to prevent the anxiety without any adverse effects.

Dexmedetomidine premedication of outpatients under IVRA

Dexmedetomidine is approximately 8 times more selective toward the alpha-2-adrenoceptors than clonidine. It induces analgesia in patients and decreases anesthetic requirements by up to 90%. The current study aimed to evaluate the effects of dexmedetomidine premedication on tourniquet pain, intraoperative-postoperative analgesic requirements, sedation levels, quality of anesthesia, and the hemodynamic parameters when used as a single dose before intravenous regional anesthesia [IVRA]. Fifty-four patients undergoing hand surgery [carpal tunnel and tendon release] were randomly divided into 2 groups for IVRA. IVRA was performed with 40 mL of 0. 5% lidocaine in both groups. A single dose of dexmedetomidine 0. 5 microg/kg in 20 mL saline was administered to group D [n=27] and placebo solution 20 mL to group C [n=27] through the non-IVRA catheter 15 minutes before IVRA. Sensory and motor block onset and recovery time, hemodynamic variables, tourniquet pain, analgesic requirements according to verbal rating scale [VRS] and visual analog scale[VAS], sedation score, and anesthesia quality were recorded in the intraoperative and postoperative period. Improved quality of anesthesia, reduced postoperative pain scores, and total analgesic requirements were found in group D during postoperative period. Additionally, the patients experienced a higher degree of sedation during intraoperative and postoperative period. The premedication of 0. 5 microg/kg low dose dexmedetomidine before IVRA improves the quality of anesthesia and decreases the postoperative analgesic requirement of outpatients undergoing hand surgery without any serious side effects

Dexmedetomidine use during strabismus surgery in agitated children

We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. We enrolled 60 agitated pediatric patients, aged 4.5-11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 mg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1-3 mg/kg/h i.v. [n=30]. Patients were intubated after receiving fentanyl 1 mg/kg and rocuronium bromide 0.5 mg/kg. 21 [70%] patients in group D did not show the oculocardiac reflex [OCR] versus 7 [23%] in group P [p=0.0006]. The preoperative and postoperative agitation scores [p=0.0001 and p=0.03, respectively], the score on the Faces Pain Scale during awakening [3.0 [interquartile range, IQR 2.0-4.0] in group D and 0.0 [IQR 1.0-2.25] in group P] [p=0.001] and at the 60th postoperative minute [IQR 2.0 [1.5-3.0] in group D and 2.0 [IQR 1.5-3.0] in group P] [p=0.004], sore throat [26.6% in group D and 60% in group P] [p=0.01] and analgesic requirement [20% in group D and 53% in group P] [p=0.01] in group P were significantly higher than in group D. The Ramsay Sedation Score [RSS] in group D was significantly higher than in group P during awakening [2.0 [2.0-2.0] in group D and 4.5 [4.0-5.0] in group P] [p=0.0001]. Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery